Project Summary: Provisions in the Affordable Care Act allow states substantial flexibility and opportunity to restructure their Medicaid programs. Given the disproportionate share of racial and ethnic minorities areas covered by the Medicaid program, changes in Medicaid policy provide a unique opportunity to address health disparities. However, Medicaid policies also face significant challenges, particularly in the ways in which this relatively low-reimbursing insurance program has left beneficiaries with problems of access and quality. One of the more ambitious Medicaid transformations has occurred in Oregon, which launched its system of ?Coordinated Care Organizations,? or CCOs, in 2012. In legislation outlining the CCO model, the State of Oregon explicitly identified ?Health Equity and Eliminating Health Disparities? as a fundamental target for delivery system changes. CCOs are required to: submit Community Health Improvement Plans, with goals for reducing disparities; provide services geographically located close to where members reside and offered in nontraditional settings that are accessible to diverse communities and underserved populations; provide incentives to attract underrepresented minority groups into the healthcare workforce; and broaden the use of community health workers. Using extensive claims and Electronic Health Record data and building on large policy experiment in Oregon, this proposal aims to assess the ways in which racial and ethnic disparities can be reduced through Medicaid reform, while also tracking the extent to which access and quality change for rural populations and the Medicaid program at large during these significant reform and expansion periods.